Wingate La'Marcus T, Coleman Margaret S, Posey Drew L, Zhou Weigong, Olson Christine K, Maskery Brian, Cetron Martin S, Painter John A
Division of Global Migration and Quarantine; Centers for Disease Control and Prevention; Atlanta, Georgia, United States of America.
PLoS One. 2015 Apr 29;10(4):e0124116. doi: 10.1371/journal.pone.0124116. eCollection 2015.
The Centers for Disease Control and Prevention is considering implementation of overseas medical screening of student-visa applicants to reduce the numbers of active tuberculosis cases entering the United States.
To evaluate the costs, cases averted, and cost-effectiveness of screening for, and treating, tuberculosis in United States-bound students from countries with varying tuberculosis prevalence.
Costs and benefits were evaluated from two perspectives, combined and United States only. The combined perspective totaled overseas and United States costs and benefits from a societal perspective. The United States only perspective was a domestic measure of costs and benefits. A decision tree was developed to determine the cost-effectiveness of tuberculosis screening and treatment from the combined perspective.
From the United States only perspective, overseas screening programs of Chinese and Indian students would prevent the importation of 157 tuberculosis cases annually, and result in $2.7 million in savings. From the combined perspective, screening programs for Chinese students would cost more than $2.8 million annually and screening programs for Indian students nearly $440,000 annually. From the combined perspective, the incremental cost for each tuberculosis case averted by screening Chinese and Indian students was $22,187 and $15,063, respectively. Implementing screening programs for German students would prevent no cases in most years, and would result in increased costs both overseas and in the United States. The domestic costs would occur because public health departments would need to follow up on students identified overseas as having an elevated risk of tuberculosis.
Tuberculosis screening and treatment programs for students seeking long term visas to attend United States schools would reduce the number of tuberculosis cases imported. Implementing screening in high-incidence countries could save the United States millions of dollars annually; however there would be increased costs incurred overseas for students and their families.
美国疾病控制与预防中心正在考虑对学生签证申请人实施海外医学筛查，以减少进入美国的活动性肺结核病例数量。
评估对来自不同结核病流行率国家、前往美国的学生进行结核病筛查和治疗的成本、避免的病例数以及成本效益。
从两个角度评估成本和效益，即综合角度和仅美国角度。综合角度从社会层面总计海外和美国的成本与效益。仅美国角度是对国内成本和效益的衡量。构建决策树以从综合角度确定结核病筛查和治疗的成本效益。
仅从美国角度看，对中国和印度学生的海外筛查项目每年可防止157例结核病输入，节省270万美元。从综合角度看，中国学生的筛查项目每年成本超过280万美元，印度学生的筛查项目每年近44万美元。从综合角度看，通过筛查中国和印度学生避免每例结核病的增量成本分别为22,187美元和15,063美元。对德国学生实施筛查项目在大多数年份无法避免病例，且会导致海外和美国的成本增加。国内成本的产生是因为公共卫生部门需要对在海外被确定为结核病风险较高的学生进行随访。
对寻求长期签证前往美国学校就读的学生开展结核病筛查和治疗项目将减少输入性结核病病例数量。在高发病率国家实施筛查每年可为美国节省数百万美元；然而，学生及其家庭在海外将产生额外成本。
